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Long-term outcomes of endoscopically resected laterally spreading tumors with a positive histological lateral margin

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Abstract

Background

With advances in diagnostic endoscopy, the incidence of superficial colorectal tumors, including laterally spreading tumors (LSTs), has increased. However, little is known about the long-term results of LSTs with positive lateral margin after endoscopic treatment. This study aimed to evaluate the long-term clinical outcomes and risk factors for local recurrence of LSTs with positive lateral margin after initial endoscopic resection.

Methods

We performed a retrospective analysis of the medical records of 324 patients who had 363 LSTs with positive lateral margin after endoscopic resection at a tertiary academic medical center. The medical records from 2011 to 2015 were analyzed. Local recurrence was confirmed through endoscopic finding and subsequent biopsy analysis. We assessed the local recurrence rate and performed multivariate analyses to identify the factors associated with local recurrence.

Results

Follow-up colonoscopy was performed in 176 of 363 LSTs. The local recurrence rate was 6.3% (11/176), with a median (interquartile range [IQR]) follow-up period of 19.8 (12.4–46.5) months. In multivariate analysis, local recurrence was associated with piecemeal resection (odds ratio [OR] 6.62, 95% confidence interval [CI] 1.28–34.33; p = 0.024) and inversely associated with thermal ablation (OR 0.033, 95% CI 0.00–0.45; p = 0.011). At surveillance colonoscopy, histology of the recurrent tumor was adenoma in 10 (90.9%) of 11; these were treated endoscopically.

Conclusions

In this retrospective study, we found that endoscopically resected LSTs with positive lateral margin have a low recurrence rate. Piecemeal resection was associated with higher local recurrence, and thermal ablation was inversely associated with local recurrence. Endoscopic resection with positive lateral margin combined with thermal ablation leads to a low recurrence rate.

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Acknowledgements

We thank the Department of Biostatistics, Clinical Trial Center, Biomedical Research Institute, and Pusan National University Hospital for their excellent assistance in the statistical analysis.

Funding

This study was supported by a Biomedical Research Institute Grant (2016-A011) from Pusan National University Hospital.

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Authors and Affiliations

  1. Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, Busan, 49421, South Korea

    Eun Young Park, Dong Hoon Baek, Geun Am Song, Gwang Ha Kim & Bong Eun Lee

  2. Department of Pathology, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea

    Do Youn Park

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  1. Eun Young Park
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Correspondence to Dong Hoon Baek.

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Eun Young Park, Dong Hoon Baek, Geun Am Song, Gwang Ha Kim, Bong Eun Lee, and Do Youn Park have no conflict of interest.

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Park, E.Y., Baek, D.H., Song, G.A. et al. Long-term outcomes of endoscopically resected laterally spreading tumors with a positive histological lateral margin. Surg Endosc 34, 3999–4010 (2020). https://doi.org/10.1007/s00464-019-07187-x

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